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Data regarding criminal behaviour and expenditure on illicit drugs by 300 methadone patients and 997 heroin users who participated in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) [...]

Symptoms are vital representations of human disorders, are key to understanding disorders, and may be the focus of specific therapeutic efforts. Symptoms are imperfect, and there are many influences on how they are described and understood. Are they hand servants of diagnosis or important in their own right? The answer seems to be both, but diagnosis is typically the way in which communication about psychopathology occurs internationally in many clinical disciplines. Diagnosis is also the basis of knowledge of the natural history of psychopathology and its treatment and therapy. Investigations into the nature and meaning of symptoms can helpfully focus on emerging disorders, of which gaming disorder is provided as an example.

In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM‐5). In 2019, the World Health Assembly approved the 11th revision of the International Classification of Diseases (ICD‐11). It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD‐11 and DSM‐5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the two systems, including the appointment of an ICD‐DSM Harmonization Group. This paper evaluates the success of these harmonization efforts and provides a guide for practitioners, researchers and policy makers describing the differences between the two systems at both the organizational and the disorder level. The organization of the two classifications of mental disorders is substantially similar. There are nineteen ICD‐11 disorder categories that do not appear in DSM‐5, and seven DSM‐5 disorder categories that do not appear in the ICD‐11. We compared the Essential Features section of the ICD‐11 Clinical Descriptions and Diagnostic Guidelines (CDDG) with the DSM‐5 criteria sets for 103 diagnostic entities that appear in both systems. We rated 20 disorders (19.4%) as having major differences, 42 disorders (40.8%) as having minor definitional differences, 10 disorders (9.7%) as having minor differences due to greater degree of specification in DSM‐5, and 31 disorders (30.1%) as essentially identical. Detailed descriptions of the major differences and some of the most important minor differences, with their rationale and related evidence, are provided. The ICD and DSM are now closer than at any time since the ICD‐8 and DSM‐II. Differences are largely based on the differing priorities and uses of the two diagnostic systems and on differing interpretations of the evidence. Substantively divergent approaches allow for empirical comparisons of validity and utility and can contribute to advances in the field.

Studies have revealed that substance-use disorders are a significant cause of death and disability and that most of the police arrestees had at least one substance-use-disorder. Australian community has identified the need for the development of services for detoxification and its treatment.

The Eleventh Revision of the International Classification of Diseases (ICD‐11) was formally published in May 2019. Alcohol use disorders form a key part of the section of Disorders due to Substance Use and Addictive Behaviours. This review describes and discusses the alcohol diagnoses within this section of ICD‐11, including Alcohol Dependence, Harmful Pattern of Use of Alcohol, and entities such as Alcohol Intoxication, Alcohol Withdrawal, and several alcohol‐induced mental disorders, and briefly covers Hazardous Alcohol Use, which is listed separately as a health risk factor. We summarize the historical background to the development of these diagnoses, including work within the World Health Organization since the 1970s, and the corresponding diagnoses in the current ICD‐10. The process by which ICD‐11 diagnoses have been made is described and may be summarized as a conceptual–pragmatic–confirmatory one. The available empirical data supporting the ICD‐11 diagnoses are presented, particularly in relation to the diagnostic guidelines for Alcohol Dependence. Comparison is made with the corresponding diagnoses in ICD‐10 and their nearest counterparts in the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders. Field testing of the ICD‐11 diagnoses is currently in progress. A plea is made for matching of diagnoses, diagnostic guidelines/criteria, and the assessment tools intended to capture these diagnoses. In ICD‐11 the diagnosis of Alcohol Dependence has been retained, in simplified format, as the central alcohol use disorder. Concordance with its ICD‐10 and DSM‐IVequivalents is excellent, but it does not tally well with the broadly formulated DSM‐5 Alcohol Use Disorder. Work is needed to develop the most effective crosswalk between the two. ICD‐11 Harmful Alcohol Use is a non‐dependence disorder; it signifies repeated alcohol consumption which has caused harm or through the person's behaviour, harm to others.

Following approval of the ICD‐11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD‐10 to the ICD‐11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD‐11 Mental, Behavioural and Neurodevelopmental Disorders following ICD‐11’s approval. The development of the ICD‐11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD‐11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture‐related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery‐based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD‐11 classification of mental disorders as compared to the ICD‐10, and the development of two new ICD‐11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD‐11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD‐11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD‐11 and in preparing for implementation in their own professional contexts.

Effective evidence-based treatments for heroin uses in Australian are examined.

The costs of alcohol abuse to innocent bystanders in Australia have not received a lot of attention but alcohol abuse cost Australia $4.5 billion in 1992. Collateral damage includes damage to fetuses from mothers who abuse alcohol, damage to innocents and property when people drive drunk and damage from the impaired judgment of doctors using alcohol. Much of this damage could be prevented by stricter liquor laws and law enforcement, taxation by alcohol content and other public policy initiatives.

Abstract: This article represents the proceedings of a symposium at the 2002 joint conference of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism in San Francisco. The chair was John B. Saunders. The focus of the symposium was on brief intervention approaches for hazardous drinking among young people. The presentations were (1) Evidence for the effectiveness of brief intervention as an approach to reducing hazardous alcohol use, by John B. Saunders; (2) College student hazardous drinking in New Zealand, the USA, UK, and Australia: implications for research, policy, and intervention, by Kypros Kypri; (3) Applications of motivational feedback on the college campus, by Scott T. Walters; (4) A population based individualized alcohol harm reduction feedback intervention: preliminary results from the college‐based alcohol risk reduction (CBARR) trial, by Robert G. Laforge; and (5) Brief interventions: conclusions and future directions, by Mary E. Larimer.

Background: Estimates of the performance of carbohydrate deficient transferrin (CDT) and gamma glutamyltransferase (GGT) as markers of alcohol consumption have varied widely. Studies have differed in design and subject characteristics. The WHO/ISBRA Collaborative Study allows assessment and comparison of CDT, GGT, and aspartate aminotransferase (AST) as markers of drinking in a large, well‐characterized, multicenter sample.

Excessive consumption of alcohol is a serious public health problem. While intensive treatments are suitable for those who are physically dependent on alcohol, they are not cost-effective options for the vast majority of problem drinkers who are not dependent. There is good evidence that brief interventions are effective in reducing overall alcohol consumption, alcohol-related problems, and health-care utilisation among nondependent problem drinkers. Psychologists are in an ideal position to opportunistically detect people who drink excessively and to offer them brief advice to reduce their drinking. In this paper we outline the process involved in providing brief opportunistic screening and intervention for problem drinkers. We also discuss methods that psychologists can employ if a client is not ready to reduce drinking, or is ambivalent about change. Depending on the client's level of motivation to change, psychologists can engage in either an education-clarification approach, a commitment-enhancement approach, or a skills-training approach. Routine engagement in opportunistic intervention is an important public-health approach to reducing alcohol-related harm in the community.

Background. This paper describes the study design, recruitment, measurement, and initial recruitment outcomes of Australia's largest workplace intervention trial, the National Workplace Health Project.

Background: There is compelling evidence that genetic factors play a major role in the development of alcohol dependence. Platelet adenylyl cyclase (AC) activity has been proposed as a biochemical marker for differentiating alcohol‐dependent and nondependent subjects, but the sensitivity and specificity of this marker have not been ascertained. The objective of this study was to determine the sensitivity and specificity of platelet AC activity in identifying alcohol‐dependent subjects and to ascertain the effect of medical/psychiatric variables, drinking and smoking history, and age and body weight on AC activity.

Problem drinking constitutes a broad spectrum of drinking practices, levels of consumption and harmful consequences. This spectrum is represented by the treatment research examined in this review, which covers inpatient programmes, the role of specialist services, Alcoholics Anonymous, cognitive-behavioural therapies, and early intervention. Some current controversies are highlighted.

Objective: The drug and alcohol related knowledge and attitudes of trainee psychiatrists were examined to obtain a baseline measure of these factors in order to determine whether current training is appropriate and adequate.Method: A questionnaire was distributed to trainees enrolled in the training program of the Royal Australian and New Zealand College of Psychiatrists in New South Wales, Victoria, Queensland and South Australia (N=425). Questions were asked relating to theoretical knowledge, diagnostic and problem solving skills for a number of drug groups; further questions concerned the respondents' attitudes and opinions on aspects of management.Results: Sixty per cent of recipients returned the questionnaire. Theoretical and applied knowledge levels were of an adequate standard overall, but highly variable. Notable areas of weakness included knowledge of opiates, barbiturates and stimulants. Trainees' views regarding treatment options were also variable. Alcoholics Anonymous was considered the best supported form of treatment from evidence from controlled trials. Low levels of self efficacy and little support were recognised for early intervention strategies.Conclusions: While positive views were generally expressed towards involvement with patients with alcohol and drug problems, specific strategies to enhance training and performance are needed. Findings are discussed in terms of continuing education. It is recommended that if sufficient training in this area is not provided then psychiatrists will have little confidence in appropriate therapeutic approaches in treating substance misusers.

To determine the prevalence of previously undiagnosed problem drinking and thereby to assess the suitability of the emergency department for early intervention. Three hundred and fifty ambulatory care patients were assessed by means of a structured interview schedule, physical examination and blood tests. Alcohol intake and presence of alcohol‐related problems were recorded, along with history of past advice on drinking and self‐perception of an alcohol problem. The ambulatory care section of the emergency department of Royal Prince Alfred Hospital, Sydney. Three hundred and fifty subjects, aged between 18 and 55 years, were sequentially selected over an 18‐month period. Forty‐one per cent of subjects (95% confidence interval, 36%‐46%), 50% of men and 26% of women, were classified as problem drinkers on the basis of hazardous or harmful levels of alcohol consumption, frequent drinking to intoxication, evidence of dependence, or experience of alcohol‐related problems. Of these, 63% had not previously received advice on drinking from a health professional and only 28% perceived they had a problem. Of particular note was that 24% of men and 4% of women were drinking 12 or more drinks (120 g of alcohol or more) in a single session on a weekly or more frequent basis. Many of the problem drinkers attending the emergency department have not previously received advice about their drinking from a health professional. The emergency department therefore offers considerable potential as a site for early detection and intervention in patients with hazardous and harmful alcohol use and related disorders.

A survey was undertaken in Sydney in 1989 to identify factors associated with behaviour involving risk for human immunodeficiency virus infection. Self‐report data on needle‐sharing and sexual practices were collected from 91 heroin users entering a residential, drug‐free detoxification unit. Data were analysed using polytomous and ordinal logistic regressions. Heroin‐dependent subjects who also had a current alcohol problem were significantly more likely than others to report high risk needle‐sharing behaviour. Subjects with more than one sexual partner in the last three months were significantly more likely to use condoms while those with a current benzodiazepine problem were significantly less likely to use condoms. Qualitative data suggest that high risk needle‐sharing behaviour most often occurred around the time of relapse to injecting drug use and among homeless drug users occupying derelict buildings in inner‐city suburbs.

Abstract: To establish baseline data on Family Medicine Programme trainees' knowledge of and attitudes to drug and alcohol problems, we posted questionnaires to all trainees in New South Wales, Queensland, Victoria and South Australia. A total of 1647 trainees was surveyed, with a response rate of 55 per cent (n=908). The mean age of respondents was 29 years and 54 per cent were female. The majority of respondents (58 per cent) were in their final year of training. Overall knowledge levels were reasonably good (the mean score was 76 per cent), but there were significant areas of deficit. Senior trainees generally performed better than their junior counterparts. Knowledge was best for alcohol and weakest for opiates. Attitudes towards involvement with drug and alcohol problems were very positive; however, confidence in the efficacy of various interventions was mixed.

Objectives.Comparatively little is known about the most effective educational strategies to train medical students to successfully intervene in their patients' alcohol problems. The relative effectiveness of two educational programs to teach medical students brief intervention skills for managing alcohol problems was examined.

Starting in 1989, an attempt was made to change the aim of methadone treatment in NSW from abstinence to harm-minimisation. A study was undertaken to measure change in attitudes among staff working in public methadone programs in Sydney. Using scales developed in a 1989 survey, we found a statistically significant and meaningful reduction in support for abstinence-oriented policies had occurred by 1992. There was no change in staff?s support for the punishment of illicit drug use or their knowledge of the risks and benefits of methadone maintenance. This suggests problems with staff attitudes and, indirectly, the effectiveness of public health interventions, can be addressed using educational campaigns.

The meaning of the word craving varies as illustrated by Kozlowski and Wilkinson's reports of ambiguities in use amongst cigarette smokers. We extended this line of investigation to problem drinkers who sought a goal of controlled drinking versus abstinence, to professionals involved in the addictions area, and to university students. Significant differences in meaning were noted particularly among the problem drinkers (N= 256 between 17 and 60 years of age). Reasons for this are offered.

INTRODUCTION There is a growing appreciation of the significance of the intervertebral disk in its relationship to spinal disease. When it is remembered that the disks make up a full quarter of the total length of the presacral portion of the spinal column, it is evident that these structures constitute an extensive organ. In point of fact it may be said that the greater majority of conditions resulting in spinal deformity or in derangement of spinal function are primarily the outcome of involvement of the intervertebral disks.For a clear appreciation of the pathologic pictures and notably for the interpretation of pathologic processes and their genesis, a thorough acquaintance with the structure and function of the disks is essential. From decade to decade there are considerable variations in both the anatomic character and the physiologic competence of the disks; hence it is necessary to consider their developmental history. Nonetheless a

The great book of Andreas Vesalius of Brussels, the De humani corporis fabrica, Basle, 1543, uniquely ushered in modern science and medicine. Because of the overwhelming power and significance of this masterpiece there is a tendency to dismiss his other writings as minor and of no significance. The late Charles Singer, in a discussion on the philosophic background of Vesalius, states without equivocation, "Vesalius is a man of one book," and he continues, "One may almost say that he is a book for, despite all that is written on him, his personality is very dim."1 This categorical statement by Singer displays an unwonted degree of myopia in this eminent medical historian. However, if we wish to study either Vesalius or his book, the so-called minor works become of great importance for they disclose with great clarity not only the personality of the author but, even more importantly, the forces

Brain of 8-day-old chick embryos cultivated in vitroin plasma to which sulfonamides in various concentrations were added, responded differently in accordance with the sulfonamide tested. Cultures containing sulfadiazine and succinyl sulfathiazole grew better than the controls in all concentrations tested. The growths in sulfapyrazine and sulfapyridinie equalled those of the controls. The other sulfonamides showed varying degrees of toxicity. Preliminary experiments suggested strongly that the toxicity is to be ascribed to inherent properties of the drugs, not their pH.

Obstruction is a major and grave complication of gastric surgical procedures. Always serious and frequently calamitous, it ranks in importance second only to marginal ulcer and its sequelae. It is difficult to state with what frequency this complication occurs, for in contrast to the early days of surgery, the complication is today passed off as occasional, and few surgeons have recorded and published their figures. That the incidence is more than "occasional" is evidenced by the continuous shift in choice of procedures from one type of operation to another in an endeavor to avoid the grave consequences of its occurrence. Indeed, many surgeons at the moment have reverted to unions of the antecolic type,1 and there is an increasing tendency toward more radical measures, with resection of more or less of the stomach with or without enteroanastomosis. However, all surgeons are compelled at times to resort to gastroenterostomy of

Abstract: The New South Wales Drug and Alcohol Specialist Advisory Service aims to provide prompt, relevant and reliable advice on the clinical management of drug‐ and alcohol‐related problems to health professionals throughout New South Wales. We gauged the performance of the Service against preset indicators by interviewing 120 callers who had contacted the Service during its first two years. Accessibility and the quality of information provided were rated highly. Of the 120 respondents, 105 (90 per cent) rated the speed of response to their calls as very good or excellent, and 109 (91 per cent) considered the advice given to be very relevant to their needs. Nearly all (97 per cent) indicated their intention to reuse the Service, and 78 (65 per cent) nominated it as their preferred source of clinical advice on drug and alcohol problems. The Service has established itself as an accessible and reliable source of advice on the management of drug and alcohol problems, especially for rural health professionals. This model of a telephone‐based consultancy could have application in other medical specialities.

A photograph depicting early summer plantings and spring showers on a farm near Manchester, England is presented.

Meta‐analyses validate the NHMRC recommendations on responsible drinking